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Job Description Summary

Performs daily activities involved in the reimbursement process, i.e. claims filing/follow-up, entry of payments/adjustments, and follow-up on non-payment or payments below contracted fee schedule amount. Identifies any repetitive errors, either system or manual, take corrective action and document. Performs all tasks in a timely manner to ensure consistency in Accounts Receivables (A/R) totals and maintain a minimum of days in A/R. Using internal and external computer systems and payer portals, work traditional Medicare and Medicare Advantage/Replacement inventory to full resolution.

Job Description

Essential Functions

• Works as part of a multi-disciplinary team to provide answers to inquiries and questions;
• Troubleshoot problems and provide information;
• Handle intervention or referrals with a professional and respectful customer service focus telephonically and/or in person;
• Provides a variety of support services in connection to the day-to-day operations in a health care environment;
• Maintains working knowledge of regulatory guidelines for billing;
• Ability to verify and load insurance coverages correctly for accurate billing;
• Provides claim submission for services provided at SEH;
• Work an resolve claim edits and errors daily;
• Provides follow up on claims which did not process correctly;
• Provides follow up with insurance companies or individuals to obtain accurate reimbursement;
• Understands the use of and navigation of Medicare’s DDE system and other governmental and commercial payer websites for claim status and corrections;
• Accurately determines Part A and Part B Medicare coverages and billing requirements;
• Reviews correspondence daily for appropriate follow up;
• Able to read and understand explanation of benefit files;
• Works closely with clinical team for accurate charges and modifiers;
• Verifies third party payer coverage;
• Coordinates authorizations when appropriate;
• Works closely with coding team for accurate submission on claim;
• Process and follow up on payer denials, consulting with various entities for completion;
• Understands hospice billing requirements and regulations;
• Research and resolve client billing problems or issues;
• Provide communication on the methods and principles used for billing to the customers and resolve concerns;
• Study contractual terms and conditions of payment to ensure payments are made consistent with terms;
• Conduct work functions to assist with late charge processes;
• Works closely with third party collection vendors for accurate payment records;
• Assist patients and their families with applying for financial assistance;
• Establish payroll deduction transactions;
• Make daily deposits to the bank;
• Ensure change fill requests are complete for department’s daily function;
• Work with patients to develop self-pay arrangements and payment plans when applicable;
• Post payments for both insurance and individuals;
• Review accounts and initiate refunds when applicable;
• Communicate self-pay balances for upcoming services and collect balances due;
• Work with accounting department for accurate financial documentation;
• Edit account for correct coverage documentation;
• Apply contractual adjustments in accordance with contracts;
• Print, scan and index correspondence to the appropriate account;
• Works closely with electronic payment process vendor for accurate posting and adjustments electronically;
• Oversee the electronic flow of the account through the billing process to include bad debt;
• Performs all other duties as assigned

Direct Reports (supervised positions)

• None

Qualifications

Minimum Education Required

• High school diploma or equivalent

Minimum Education Preferred

• American Academy of Professional Coders (AAPC) Coding Certification (CPC)

Minimum Experience Required

• Working knowledge of computers
• Previous work in a business office, registration or clinical setting

Minimum Experience Preferred

• One (1) year of revenue cycle experience
• Working knowledge of CPT and ICD 10 coding systems

Required Skills/Abilities

• Use of a standard computer keyboard and ten (10)-key calculator
• Effective written, verbal and interpersonal communication skills
• Ability to interact with customers in both hospital and clinic environments.

Shift

Day

Shift Details

8:00 am - 4:30 pm

FTE

1

Type

Regular

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Equal Employment Employer

Southeast Health is committed to provide equal employment opportunity (EEO) to all persons regardless of age, color, national origin, citizenship status, physical or mental disability, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status, or any other characteristic protected by federal, state or local law. In addition, Southeast Health will provide reasonable accommodations for qualified individuals with disabilities.